Online Medical Chats

Get Smart about Head and Neck Cancer

Kristin Philbin (Moderator) - 11:48 AM:Welcome! Today’s chat: Get Smart about Head and Neck Cancer will begin shortly. Please start submitting your questions and Doctor Bruce Brockstein will begin answering them as soon as we get started. While you are waiting for the chat to begin, feel free to visit the Head and Neck Cancer page to obtain more information about head and neck cancers.

Dr. Bruce Brockstein (NorthShore) - 12:01 PM:Good afternoon,
My name is Bruce Brockstein. I am a medical oncologist at NorthShore University HealthSystem, and a specialist in cancers of the "head and neck" (mouth, throat, larynx (voicebox, etc.
I am here today to discuss and answer any questions about the disease(s)--risk factors, treatments etc.
Please feel free to interact and ask questions.

Dr. Bruce Brockstein (NorthShore):Hi, I am not aware of this as a risk factor--at least not a dominant risk factor. Sun exposure (blistering sunburns), family history, genetic makeup, skin pigment, etc are the main risk factors.

Jerry (Skokie, IL) - 12:04 PM:If someone in my family had head and neck cancer, am I more likely to have it?

Dr. Bruce Brockstein (NorthShore):Epidemiological studies show family history as a risk factor for head and neck cancer. This can be confused or confounded by the fact that family members often share other risk factors (e.g. smoking or second hand smoke). Nonetheless there is at least a small familial component to the risk. Still, most people (great majority) of people with a family member (1st degree relative is the risk) will not get head and neck cancer.

GB (Highland Park) - 12:07 PM:I've read that the Human papillomavirus is suspected in the potential transmission, via oral sex with women, of the virus to the oral cavity which may be a cause of subsequent squamous cell formation. Is there science to confirm this? I've been faithfully married to 1 woman for 27 years, but had other encounters prior, & wonder about the ramifications of this theory. Is oral sex a risk behavior? What if with only 1 person, &/or how long might cell mutation take, per my 27 yr for example?

Dr. Bruce Brockstein (NorthShore):HPV is a risk factor for the development of head and neck cancer especially the base of tongue and tonsil. We are now just beginning to recognize this and its implications. The rate of these cancers are going up 5-10% per year--most notably in younger, white, non-smoking men (though others too).
AS far as we can tell, the majority of the data point to the fact the infection that is causative takes place many many years before the cancer-- e.g. 10-40 years before.
I'll come back to this more during a pause.
You're question though is excellent and an important concern to many with this disease
briefly too, people with HPV related cancers have a better prognosis than those without HPV.
Brings up the vaccine question.

Dominic (Highland Park, IL) - 12:12 PM:I heard that tobacco is the leading cause of head and neck cancers, is this correct?

Dr. Bruce Brockstein (NorthShore):Yes, traditionally this is the biggest risk (in the U.S.)
The more one smokes, the bigger the risk (number of years and number of cigarettes). Alcohol definitely adds to this risk further.
In the U.S. 75-80% of those with this cancer are smokers and/or alcohol drinkers.
In China and other places, infection with EBV is a big risk.
Chewing tobacco is a very big risk for oral cancers, and in India, oral cancer is the #1 cause of cancer (chewing tobacco plus the BETEL nut, are main risks there).

Jerry (Skokie, IL) - 12:14 PM:If I have had HPV does that mean I am more likely to be at risk for these cancers?

Dr. Bruce Brockstein (NorthShore):We're still learning about this. Most important is which type of HPV (type 16 is main one attributed to head and neck cancer, as opposed the the more common types that cause warts. ). Those with evidence of type 16 infection in the past have a risk of getting this cancer, but still more likley not to get it.

Elisabeth Conroy (Saratoga Springs, NY) - 12:17 PM:My friend (age 70) was diagnosed with cancer of the soft palette, roof of the mouth, tonsils, back of tongue, and jaw. They opted to go ahead with the chemo first. He has had 2 rounds of Taxol & Carboplaten one week apart. Is this the standard protocol and is it up-to-date?

Dr. Bruce Brockstein (NorthShore):There are a few approaches that are "standard" Your friend's treatment is definitely in the boundry of "normal" Surgery would be debilitating, and I am assuming they will give him chemo for 6-12 weeks followed by radiation and probably simultaneous chemotherapy.
Carboplatin and taxol are very good drugs for this.

Jerry (Skokie, IL) - 12:21 PM:I used to smoke when I was younger, but quit and have not smoked for many years am I still at a higher risk for these cancers?

Dr. Bruce Brockstein (NorthShore):Smoking becomes a risk at about 10 "pack years" -- for example half a pack per day for 20 years. The risk fades with time from stopping, and becomes near "normal" risk after about 20 years of not smoking.

Dr. Bruce Brockstein (NorthShore):Harder to answer without details.
Typically he would get either "standard" radiation (3D or "IMRT" with "200 cGy" radiation daily for about 7-8 weeks), or "hyperfractionated"-- 2 treatments daily in smaller amounts for about 6 weeks.

Dr. Bruce Brockstein (NorthShore):These are the best defined.
Behind these are family history, radiation exposure, some less well-defined occupational exposures, betel nuts, and maybe dietary factors.

Jerry (Skokie, IL) - 12:25 PM:How do I know if surgery, radiation or chemotherapy is the right treatment for me?

Dr. Bruce Brockstein (NorthShore):Each individual person and each tumor is different.
Examples- a small tumor on the side of the tongue is best treated with surgery. Most tumors in the back of the throat are best approached with radiation (+/- chemotherapy).
The health of the patient/individual is of course an important factor. Sometimes there are equal choices and we talk our patients through the options.

Dr. Bruce Brockstein (NorthShore):Hopefully I am answering from the angle you mean to get at.
The cancer starts from an individual abnormality or mutation in a single or group of cells, that over time (months or years) multiply without control to become an actual tumor. A tumor 1 cm (0.4 inches) in size has about a billion cells.

Elisabeth Conroy (Saratoga Springs, NY) - 12:30 PM:Finally, is the chemotherapy considered useful in shrinking a tumor before radiation therapy, and could either shrink the tumor enough for possible surgical intervention without great disfigurement?

Dr. Bruce Brockstein (NorthShore):In some cases, yes, the chemo can make the tumor more operable, however in general, even with a smaller tumor, the same tissues need to be removed. From your description of this particlular case, it sounds like radiation will be best. In about 25-30% of the cases the tumor will be all gone or nearly gone after the chemo (though needs radiation still or will grow back) and about 75% of cases it will be half the size or smaller.

Dr. Bruce Brockstein (NorthShore):Good question.
Don't smoke or chew tobacco (or use pipe, cigar, marijuana, second hand smoke).
Keep alcohol to less than 1-2 ounces/drinks per day.
Good dental care (I left that off the previous questioner's answer about risk factors, that poor dental hygiene, lack of tooth brushing, lots of cavities etc, are a risk factor)
We cant change our genetics or past HPV exposure (though might be able to avoid further exposure to HPV).

Patricia (Lincolnshire, IL) - 12:35 PM:Beside melenoma, what are the most common forms of skin cancer?

Dr. Bruce Brockstein (NorthShore):The most common are basal cell and squamous. Basal cell cancers rarely spread or cause major problems. Squamous cell cancers spread to lymph nodes on occasion. melanoma is the least common but he most dangerous (though most people with melanoma are cured)
Sun exposure is a big risk factor for all 3 types.

Dominic (Highland Park, IL) - 12:38 PM:Are there many specialists within this field? How do I know which one to go to?

Dr. Bruce Brockstein (NorthShore):The main people that make up the treatment team are medical oncologists (my field), radiation oncologists (who treat with radiation) and ENT/surgical oncologists--who operate and/or help with diagnosis, staging procedures and care during treatment.
You should be treated at a place with a multidisciplinary team with an established "head and neck cancer" program.
I would be happy to give you more information and/or to help in your treatment.

Dominic (Highland Park, IL) - 12:41 PM:What are some clear warning signs to look out for with not only myself, but also for friends and family?

Dr. Bruce Brockstein (NorthShore):A non-healing sore in the mouth or throat. Persistent throat pain/sore throat--especially on just one side, persistent ear pain without ear infection, difficulty swallowing or speaking, hoarseness, persistent nosebleeds, weight loss in combination with some of the above, persistent foul odor in mouth with some of the above.

Dr. Bruce Brockstein (NorthShore):I am not familiar with Albany Medical, but he should be seen at least for a consult at a center that treats a lot of these cancers. Likely the stage is at least 3 from your description.

Jerry (Skokie, IL) - 12:44 PM:How is it that poor dental care could be a risk factor for head and neck cancer? What is the exact correlation?

Dr. Bruce Brockstein (NorthShore):It is not clear. First, some of the same people with poor dentition also are chronic alcohol users or smokers, so this may be a "confounder'. But it is though that the chronic inflammation from bacterial infection may set up an environment favorable for carcinogenesis.

Dominic (Highland Park, IL) - 12:48 PM:I drink a couple of glasses of wine on the weekends, sometimes more at a party or business function, should I be concerned about head and neck cancer?

Dr. Bruce Brockstein (NorthShore):In general it is the chronic use of 2 or more drinks per day that leads to a risk of throat and other cancers.

Jerry (Skokie, IL) - 12:48 PM:Are the tests usually accurate?

Dr. Bruce Brockstein (NorthShore):There are different tests. Biopsy is the most accurate. CT (CAT) scans can be very suggestive, as can the physical examination of a physician/ENT.

Dominic (Highland Park, IL) - 12:49 PM:Does age play a role in this type of cancer?

Dr. Bruce Brockstein (NorthShore):The average age is 60. It is relatively rare before 40 years old.

Kristin Philbin (Moderator) - 12:50 PM:Thank you everyone for your great participation, the chat will be ending in approximately 10 minutes. Please submit any final questions you have.

Jerry (Skokie, IL) - 12:54 PM:If I have been diagnosed with one type of head and neck cancer, am I likely to have it spread to other areas?

Dr. Bruce Brockstein (NorthShore):Spread to lymph nodes in the neck is common, but can be cured in many cases.
Spreading to the lungs and other organs happens less commonly, and is very hard to treat/cure.

Jerry (Skokie, IL) - 12:55 PM:What are the most successful treatments for head and neck cancers?

Dr. Bruce Brockstein (NorthShore):Please see the transcript a few questions back. It is very dependent on the individual tumor and person (as to whether surgery, radiation, chemotherapy, or some combination, will be best).

Dominic (Highland Park, IL) - 12:56 PM:How can a person be tested for these cancers?

Dr. Bruce Brockstein (NorthShore):Best place to start is with an exam by your physician, or an ear, nose and throat specialist.

Patricia (Lincolnshire, IL) - 12:57 PM:Does cancer develop in the abnormal or mutated cell at the site of the cancer as opposed to cancerous cells in the blood stream finding a "weak" place to grow?

Dr. Bruce Brockstein (NorthShore):Good question. The "primary" starts at the mutated site you mention. Example, a tumor in the breast is breast cancer, and if it spreads by the bloodstream to the liver it is breast cancer, metastatic to liver--not liver cancer, per se.

Dr. Bruce Brockstein (NorthShore) - 1:02 PM:Thank you for joining in on this chat.
For more information you can visit our website at northshore.org.
You can make an appointment to see me at 847.570.2112, and/or get referrals to other specialists as needed.
Thank you,
Bruce Brockstein, M.D.